Etiology — what causes it
Load-related changes at the proximal hamstring origin at the ischial tuberosity. Compression at the bony origin contributes — explaining the prominence of seated pain. Common in runners, sprinters, and dancers.
Epidemiology — who gets it
Common in distance runners, sprinters, and athletes who do repetitive deep hip flexion (dancers, hurdlers). Often middle-aged runners after a training change.
Clinical signs
Tenderness at the ischial tuberosity, pain with hamstring bridge or hamstring loading in deep hip flexion, positive Puranen-Orava test (long-sit stretch), and modified bent-knee stretch test (Cacchio et al.).
Symptoms
Deep buttock or upper posterior thigh pain, worse with prolonged sitting (especially on hard surfaces), acceleration, hill running, and uphill terrain. May refer down the posterior thigh.
Best evidence for chiropractic treatment
Isometric loading and heavy slow resistance protocols form the foundation (Goom et al., JOSPT). Compression-reducing modifications early in rehab (avoiding deep hip flexion loading) speed recovery. Shockwave is a supported adjunct in refractory cases.
When to seek emergency care
Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.
Bottom line
High-hamstring tendinopathy is a load capacity problem that thrives on isometric and heavy slow resistance work — but tolerates deep hip flexion loading poorly early on.